Cesareans… the Unexpected Surgery

Recently we had a mom who chose to have an induction due to the concern that her baby was over 9 1/2 pounds as of the previous week. The doctor, a family friend, was concerned that the baby was just too big to allow her pregnancy to continue although she was 2.5 weeks from being at her due date. The perinatologist disagreed and did not feel it was a medically neccessary induction, but the mom chose to do so anyway.

She entered into the hospital with induction plans using cervidil, cytotec and the foley catheter but her cervix remained unfavorable and unresponsive to allowing the birth to happen vaginally. Eventually it was determined after Pitocin proved ineffective, to have a cesarean. The baby was born, a 2.5 weeks early and ended up going to the NICU. And he weighed a pound less than the doctor suggested.

It happens. Inductions lead to more cesareans. A baby can not always be forced to evacuate on demand. This mom realized that she could not force this to happen after the fact. So she ended up with the unexpected surgery. We hear so often about inductions, that we consider them benign. And cesareans at many of our metro hospitals hover around 40% so they have become very common place.

Many women approach their births believing that a cesarean could never happen to them. Some students tell me they don’t even pay attention to the part of class on cesarean preparation because they believe it can never happen to them.

Recently I supported a mom in her third birth. The first two were out of state and several years ago. Her first was a labor that was that was long, ended up with an epidural and then pushing for four hours. It was tramatic. But the baby was healthy, born vaginally and she recovered. Her second was an induction with an epidural early on and pushing was cut in half. The next time she chose a different route. She was adamant about her exercise and took preparation classes in her strong desire to have a natural birth. This time she hired me. On her due date she woke to her water breaking. After heading to the hospital to get antibiotics, she eventually had a foley placed with low dose Pitocin and after she began contracting, called me to come. Her midwife commented that the baby was ascyncltic entering the birth canal and was quite high.

I went to work with the mom and we did inversions, and the “ketchup bottle” to back the baby out so it could reenter more aligned. We used the rebozo and did asynclitic stances and movements. We tried every position and movement I could think of using. And she labored for the whole day. We tried the tub for pain relief but when she got out and had to have more Pitocin added, she felt she could not continue without some relief. She got a little narcotic and then slept for a while. But the baby did not budge and her cervix remained the same most of the day. An epidural was placed and we hoped that this baby would move down. But after 12 hours of no change, and the baby beginning to not be as happy with the methods being used to facilitate his birth, a decision was made to have a family centered cesarean.

Yes, two vaginal births and then the third being a cesarean. This is not fair! And when the baby was born with his hand and arm above his head and his head showing little molding except for the asynclytic bulge on one side, it was clear he had gotten wedged into a baby position as soon as her water had released and he was unable to change that position. He was the lightest of all of her babies by almost two pounds. What? How can this happen? We were all disappointed and a bit dismayed at the outcome. But we also knew we had worked together as a team to try to have this baby come vaginally and had tried all we knew to do.

Today I texted with the mom and she feels confirmed she had done all she could. That this was a beautiful birth since she was able to view the birth herself and have him skin to skin nuzzled in immediately after he was born. But this was certainly the unexpected cesarean.

All cesareans are not created equal though. One mom was coerced to have her baby early due to the fear that was planted inside her. She felt she understood the risks, but did she? She was separated from her baby immediately after the surgery and with a almost preterm baby will probably face issue with breastfeeding. The separation and healing from surgery could take its toll on her abililty to bond. One baby chose the time for his birth although not optimally positioned. The mom labored and had a supportive and patient team with her. She was able to be actively aware during the surgery and bond with her baby immediately.

Unexpected is just that. Each birth is different from the next. But having a voice and an active participation in the birth can make a huge difference for the family. Here is a picture of the birth of the second mom. They used a clear drape so she could see her son emerging from her womb. It was a beautiful albiet unexpected birth experience.